Successful Quitting
Freeing Yourself from the Dangers of Smoking

By Loyd Brendan P Norella, MD, MPHM

Caloy is a 33 year old account executive who works for an advertising agencyC . He has been with his company for 6 years. In his first year, he acquired the habit of smoking, a common practice in his office. He consumes a pack of cigarettes a day on the average. Caloy got married a few months ago and he recently found out that his wife, Carla, is pregnant with their first baby. Knowing that second hand smoke is harmful to the people around him and because he wanted a “fresh start”, he decided to quit smoking, for the second time. Caloy tried to quit smoking a few weeks ago but only remained cigarette-free for a few days. This time, he wanted it to be for good. What can he do to increase his chances for success?

According to the Usage, Attitude and Image Study on Smoking Cessation conducted in 2005, 69 percent of smokers in Manila have tried to quit in that year. Dr. Jana Klauer, a New Yorkbased physician specializing in weight loss and self-help behavior change programs, suggested that formulating a plan, sticking with it for the long haul, and not giving up in the face of adversity are important. Like weight loss, quitting smoking can be achieved through following several steps, the most crucial of which is the preparation for that first day without cigarettes.

It’s Not Easy, But It’s Possible

Quitting is difficult. This is because the nicotine in cigarettes is a highly addictive chemical that activates the brain’s pleasure areas, triggering a response that causes positive reinforcement of the smoking behavior. A research by Henningfield and Benowitz has established that nicotine is potentially more addictive than caffeine, alcohol, marijuana, cocaine and even heroin. Given that nicotine is
both physically and psychologically addictive, one has to be adequately prepared and committed to quit. If you are like Caloy, or know somebody who wants to stop smoking, these are some ways to increase the chances to quit successfully.

First of all, set a definite date for quitting. Stick to that date and quit completely. This is called going “cold turkey”. Researches have shown that those who attempt to quit through weaning (lessening the number of cigarettes smoked per day) often end up forgetting about total quitting in the first place. Nevertheless, some would suggest weaning off as this would lessen the craving for cigarettes during the crucial times around the start of the quitting period. Regardless of your preferred approach, quitting takes resolve. To increase your motivation, it would greatly help to list your reasons for quitting. Caloy made this list:

• I am quitting because I do not want to harm my pregnant wife and our coming baby.
• I want to be healthy for my family.
• I don’t want to smell bad because of the cigarette smoke.
• I want to save some money.

Smoking Kills Every eight seconds, someone dies from tobacco use. Each cigarette smoked cuts at least five minutes of life on average. (WHO, 2002) Every year, there are about 20,000 smoking-related deaths in the country. About 200,000 Filipino men will develop smoking-related diseases in their productive years of age. The US Centers for Disease Control describes smoking as the single largest preventable cause of disease and premature death. In addition to nicotine, tobacco contains over 19 known cancer-causing chemicals and more than 4,000 other chemicals. The quitting process is a difficult process. Smokers may decide to quit but fall into relapse due to several factors including nicotine withdrawal symptoms and psychological dependence. There are many reasons to quit using tobacco. Knowing the serious health risks may help motivate you to quit. Prolonged use of tobacco products increases your risk of: Heart disease and heart attacks Lung disease including emphysema and chronic bronchitis Lung cancer as well as other cancers such as mouth and throat, pancreas and others Increase in blood cholesterol levels Decreased sexual function Infertility, in both males and females Weaker immune system Oral cavities and bad breath Aneurysms and strokes due to formation of blood clots Decreased ability to taste and smell Delayed wound healing Pregnancy-related problems But because of their nicotine addiction, many smokers find it difficult to stop smoking despite of their knowledge of its negative health effects

The Benefits Of Quitting Within 20 minutes of quitting - your blood pressure and pulse rate drop to normal. Within 8 hours of quitting - your carbon monoxide and oxygen levels normalize. Within 24 hours of quitting - your risk of a sudden heart attack decreases. Within 48 hours of quitting – your nerve endings begin to recover and your senses of smell and taste begin to return to normal. Within 2 weeks to 3 months of quitting - your circulation improves and lung function increases. Within 1 to 9 months of quitting - your overall energy increases and lung function start to normalize. Within 1 year of quitting - your risk of heart disease is half that of a smoker. Within 5 years of quitting – your risk for lung cancer death decreases by 50%. Within 10 years of quitting - your lung cancer death rate becomes similar to that of someone who never smoked; your risk of stroke is lowered; your general risk for developing cancers of different organs go down. Contrary to popular belief, smoking “light” cigarettes, supposedly with lowered tar and nicotine, is still bad for the health. “Light” cigarettes have about the same negative effects as “ordinary” cigarettes.

Why Quit

Indeed, many of tobacco's bad effects on health can be decreased through smoking cessation. A study in the UK found that people who stopped smoking before they reached 30 years of age lived almost as long as those who never smoked. Remember also that second hand smoke has negative effects on others. It causes serious respiratory illnesses such as bronchitis and pneumonia among children.

Preparing To Quit?

To further support your plans to quit, you may consult a doctor who can guide you in the quitting process. Here are some suggestions to help you plan your quitting strategy in preparation for the big day- your first day without cigarettes.

1. Identify the times you are most likely to smoke. Make a list of the occasions or situations that increase your craving for cigarettes. Record each time you have a cigarette using a “quit smoking diary”. Include the time of day when the craving to smoke is felt and what you are doing during that exact moment. Caloy listed down the following as his ”risky times”:
   
   • When he feels stressed at work, especially when beating deadlines;
   • When going out with his officemates and friends, usually in a bar where they also drink beer;
   • In the morning, while drinking coffee and reading the newspapers;
   • While he is driving;
   • When he feels bored and has nothing to do;
   • and After meals.
     
2. Giving up cigarettes is also easier when you avoid things that signal the need for a smoke. So be prepared to distract yourself from anything that triggers the craving for a smoke.
   
3. After you have made this list, make a plan about what you will do instead of smoking during the “risky times”. You may get some ideas in this list that Caloy made:
   
   • Chew bubble gum or hard candy instead of smoking when feeling stressed
   • If possible, change his work routine or look for alternative areas of work, those that are not associated with heavy smoking.
   • Remove ashtrays and other smoking paraphernalia from the environment.
   • Pretend to smoke with a straw during a night out with friends. Avoid going out with friends who smoke for the initial few weeks during the more crucial times after the first day of quitting. Drink beverages other than beer, which is often associated with smoking.
   • Take a walk or exercise when bored or stressed.
   • Drink tea instead of coffee as it is highly associated with cigarettes.
     
4. Let all of your friends, family, and co-workers know of your plan to stop smoking and your definite quit date. Just being aware that they know can be a helpful reminder and motivator.
   
5. If possible, hook up with a friend or relative who is also trying to quit. This way, you can both reinforce and support each other through the process.

Quitting Together

Having a friend with you while you are quitting provides a source of support. Dr. Jana Klauer suggests that for this purpose, having a group of friends is better. “Smoke Enders” or “Smokers Anonymous” in the United States are examples of that. You may also organize a small support group in your office for this purpose.

Prior to your quit date, get rid of all of your cigarettes. Remove things that you would strongly associate with smoking and clean out anything that smells like smoke, including curtains and clothes. After all, a fresh start would not be so fresh if the smell of cigarettes still wafts in the air.

As stated earlier, the difficulty in quitting is due primarily to nicotine, an addictive substance that results in withdrawal symptoms such as irritability, headaches and even dizziness and trembling, especially for former heavy smokers. When these occur, do not lose your motivation. Just keep your focus on your goal.

One of the most common reasons why people do not want to quit smoking is the possibility of gaining weight. This weight gain is primarily due to the fact that most people replace that urge for a cigarette with food. As one quits, the body also “recovers”, and taste buds regain their sensations. Hence, food tastes better. This is in addition to the direct appetite-depressing effect of nicotine.

You can protect yourself from weight gain after quitting by maintaining a “healthy kitchen”. This means having plenty of fruits or vegetables and avoiding fattening food. In addition, exercise can burn off your excess calorie intake. Exercise has also been documented to actually decrease the physical craving for cigarettes. To lessen the “oral fixation” experienced by smokers, you can chew gum or candy, especially when you are outside the house.

Also, some people say that they feel more relaxed when they smoke. Hence, they always need to puff on a cigarette especially when they are tense. From a medical point, this claim of a relaxing effect is ironic because actually, as nicotine enters your body, your heart beats faster and blood pressure increases. In fact, the “relaxing effect” of cigarettes could be due to its effect on the brain, which induces mild euphoria and temporarily heightened memory and alertness.

As the days progress after your initial quit date, there could be increased difficulty in addressing the craving for nicotine. For this purpose, many medical doctors recommend the use of smoking cessation aids. These are the medicines, gums, lozenges, sprays or patches that help lessen the body’s physical craving for nicotine. There are experts who recommend the gums instead of patches, as chewing provides an additional value of giving the person an alternative behavior to smoking. Doctors can advise you regarding non-nicotine containing prescription medications (such as bupropion and varencline) which can help lessen the withdrawal effects. Generally, these drugs are safe but you have to be closely monitored during the time you are taking them. Overall, talking actively to a health professional about these drugs can help you achieve your goal. Other alternative smoking cessation aids also include acupuncture, hypnosis and herbal remedies.

Nevertheless, these aids aren't the entire solution. These should be combined with changes in your attitudes and behaviors, as well as the environment around you. The best quit-smoking programs feature a combination of several strategies to overcome potential relapse situations. Like Caloy, if you aren't successful the first time, simply examine what happened and what didn't work. Develop new strategies, and try again. Remember, several attempts may be needed before one can truly "beat the habit." Do not give up. In the long run, you’ll be thankful that you made that crucial decision to quit.

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